Skeletal Radiology最新文献

Vertebrogenic back pain (VBP) has emerged as a potentially undiagnosed subtype of chronic low back pain that is thought to arise from structural damage and subsequent inflammatory changes in the vertebral endplates and bone marrow. Modic changes (MCs) found on MRI have been proposed to be a potential indicator for VBP. However, the pathophysiology and clinical basis for MCs are still being investigated. This literature review aims to comprehensively synthesize the available evidence on the pathogenesis, etiologies, and therapeutic outcomes associated with MCs. MCs are classified into three types based on MRI characteristics, with the potential to present with mixed types or to interconvert over time. Risk factors and hypotheses include mechanical disruption, inflammation, bacterial, and autoimmune etiologies increasingly linked to nociceptive signaling from the basivertebral nerve (BVN), causing VBP. Diagnostic and criteria standardization is a major gap for further research to produce more consistent therapeutic outcomes. Future directions with biomarkers, advanced emerging imaging techniques, and clinical translation are required to refine the clinical role of MCs in diagnosing and managing VBP.

Objectives: To review the MRI, histological, and clinical features of extraskeletal myxoid chondrosarcoma (EMC).

Methods: Retrospective review of pre-treatment MRIs in 44 patients with pathologically proven EMC. Patient demographics, tumor MR-imaging features, histology and gene rearrangements, clinical management, and follow-up were reviewed. MRI features assessed included lesion size, location, morphology, signal characteristics, and relation to adjacent structures. Correlative analysis was performed to assess associations between demographic, clinical, molecular, and MRI variables with metastatic disease.

Results: EMCs were predominantly located in the lower extremity (38/44, 86%) and deep-to-fascia (36/44, 82%). All lesions (44/44) demonstrated well-circumscribed margins. Mean maximal dimension was 8.8 cm (range 1.7-36 cm); 93% (41/44) of lesions were hyperintense on fat-suppressed T2-weighted/ STIR imaging. Post-contrast enhancement was "solid" (> 80% enhancement) in 18%, "mixed" (20-80% enhancement) in 53%, and "sparse" (< 20% enhancement) in 29%. Nodal metastases were detected on preoperative imaging in four patients (9%), and pulmonary metastases in three cases preoperatively, and five cases postoperatively (range 14-128 months). EWSR1::NR4A3 fusion rearrangements were documented in 25 tumors (57%), and non-EWSR1 NR4A3 fusions in six cases (14%). The only variable demonstrating a significant correlation with metastatic disease was "solid" pattern of lesional enhancement (p = 0.035).

Conclusions: EMC is most commonly a deep lesion of the extremities demonstrating hyperintense T2-weighted signal, internal septations, and variable patterns of enhancement on MRI. Nodal disease is relatively frequent, and prolonged surveillance is recommended as metastases may develop years after diagnosis. Although analysis is limited by small case numbers, a "solid" (> 80%) pattern of enhancement was significantly associated with metastatic disease.

Objectives: To systematically assess whether MRI-based measurements of glenoid bone loss (GBL) are comparable to CT in patients with shoulder instability.

Methods: We searched PubMed, Cochrane Library, Web of Science, and Embase for studies comparing GBL measurements between CT and MRI through May 16, 2024. We performed subgroup analyses based on 2D versus 3D imaging and linear versus area measurement methods. We conducted statistical analysis using Review Manager (RevMan) version 5.4.1, applying a random-effects model to calculate the mean difference.

Results: Eleven studies were included, totaling 492 shoulders. Of these, 119 shoulders were evaluated using 3D MRI versus 3D CT, 126 using 2D MRI versus 2D CT, 292 using the linear method, and 149 using the area method. The pooled analysis showed no significant difference in GBL measurements between MRI and CT (mean difference -0.05; 95% CI: -0.26 to 0.15; p = 0.61). Subgroup analyses also showed no significant differences (p = 0.94 for 3D, p = 0.14 for 2D, p = 0.67 for linear, p = 0.46 for area, and p = 0.51 comparing linear vs area methods).

Conclusions: MRI provides GBL measurements comparable to CT across various imaging protocols including 2D and 3D approaches and the linear and area methods. MRI may be sufficient as the sole imaging modality for comprehensive preoperative evaluation in patients with shoulder instability.

Objectives: To determine whether MRI can differentiate hips with nonspecific inflammatory conditions from controls based on measurements of the capsule and to identify the most significant measurements.

Methods: In this retrospective and case-control study, we reviewed hip MRIs containing the term "capsulitis" in the reports. Cases with other known diagnoses or confounding joint pathologies were excluded. Controls were asymptomatic hips with normal laboratory results. Three musculoskeletal radiologists independently reviewed the studies, assessing for qualitative (edema, enhancement, effusion, synovitis, and subjective thickening) and quantitative (capsular thickness in standardized planes) parameters. Interobserver agreement, group comparisons, and optimal cutoffs were analyzed.

Results: The final study group comprised 38 cases, and the control group included 51 matched subjects. Inter-reader agreement was moderate to excellent. For capsular thickness, ICC ranged from 0.49 (posterior sagittal) to 0.87 (anterior sagittal). For qualitative findings, kappa ranged from 0.59 (capsular enhancement) to 0.84 (joint effusion), the greatest being capsular thickening and effusion. All planes showed significantly larger capsular thickness in cases vs. controls (p < 0.05). Sensitivity reached 85.2% for anterior sagittal measurement (mean, 6.27 vs. 4.58 mm), and specificity reached 84% for lateral coronal (6.53 vs. 4.13 mm). Among cases, capsular signal abnormality was observed in 89.2% of cases, pericapsular edema in 91.9%, capsular enhancement in 97.3%, pericapsular enhancement in 94.6%, joint effusion in 81.1%, synovitis in 89.2%, and capsular thickening in 100% of cases.

Conclusions: Our study reveals increased hip capsular thickness in nonspecific inflammatory conditions of the hip (capsulitis), both for qualitative and quantitative assessments.

Objective: To develop a predictive model for estimating the histological response to preoperative chemotherapy based on imaging data in patients with Ewing sarcoma.

Materials and methods: We included 133 patients with Enneking stage IIB or IIIB Ewing sarcoma who underwent chemotherapy and definitive surgery between 2003 and 2020. We analyzed various radiological parameters before and after preoperative chemotherapy. The necrotic area was evaluated using gadolinium-contrasted magnetic resonance imaging (radiological necrotic grade). Patients were classified as good histological responders if > 95% of their resected specimens showed necrosis; otherwise, they were classified as poor responders. Radiological parameters were assessed using the least absolute shrinkage and selection operator (LASSO) with cross-validation. Optimal regularization parameters were identified as those minimizing cross-validation error. The area under the curve (AUC) was calculated based on the predictive model with the selected parameters for training and test data using receiver operating characteristic (ROC) curve.

Results: LASSO models identified key parameters including volume change, radiological necrotic grade, complete regression of the extraskeletal component, and the disappearance of peritumoral gadolinium-enhancement after preoperative chemotherapy. ROC curve analysis showed that the predictive model achieved measurable discrimination ability on both training and test datasets (AUC = 0.89 [95% confidence interval (95%CI); 0.83-0.95] on training data, 0.77 [95%CI; 0.58-0.95] on test data).

Conclusion: The developed model may facilitate accurate monitoring of the efficacy of preoperative chemotherapy in patients with Ewing sarcoma. Identifying patients with a poor histological response to preoperative chemotherapy can aid in the planning of secure surgical margins and effective treatment strategies.

Paget's disease of bone (PDB) is a skeletal remodeling disorder diagnosed primarily via radiographs. In long bones, the early lytic stage of the disease is characterized by flame-shaped or blade of grass radiolucent bone resorption beginning in subchondral bone with variable length of extension into the metadiaphysis, and the later stages show bone expansion, cortical thickening, and coarsening of the trabeculae [1, 2]. Despite the usually diagnostic features, other considerations with overlapping appearance include aggressive benign and malignant bone tumors [3]. Malignancy such as lymphoma can present shared clinical features to PDB. When there is doubt as to the diagnosis, biopsy should be performed. A 60-year-old male presented with chronic left lower extremity pain. Radiographs showed a flame-shaped lytic lesion in the left femur with corresponding uptake on the bone scintigraphy. Radiographic features were suggestive of PDB, but due to some atypical findings, a biopsy was performed and showed small lymphocytic lymphoma (SLL) in the setting of chronic lymphocytic leukemia (CLL). This diagnosis led to the patient being promptly treated with targeted therapy and radiation. Pathologic verification is critical in an aberrant presentation of PDB to mitigate misdiagnosis and establish an appropriate therapeutic course.

Objectives: EOS bi-planar imaging enables three-dimensional (3D) reconstructions of the spine and pelvis with segmental vertebral measurements in three planes from a neutral pelvis. This study evaluates the repeatability of these measurements and the accuracy in detecting true changes.

Methods: Twenty patients from four clinical backgrounds (surgical threshold, bracing threshold, micro-dose, and in-brace) were included. EOS bi-planar "full spine" images were modelled and then subsequently re-modelled at least 4 weeks later by the same researcher. All 3D measurements were recorded and compared.

Results: The average modelling interval was 6.7 weeks. Paired measures indicated high agreement, except for planes of maximal curvature (PMC): thoracic (Spearman's = 0.67; p < 0.05) and lumbar (Spearman's = 0.40; p > 0.05). Intraclass correlation coefficients (ICCs) showed excellent agreement, with thoracic and lumbar Cobb angles averaging 0.99. Sagittal measurements ranged from 0.93 (L1/S1 lordosis) to 0.96 (T1/T12 kyphosis). Pelvic parameters ranged from 0.88 (obliquity) to 0.99 (tilt). The transverse profile ranged from 0.82 (apical thoracic rotation) to 0.98 (average lumbar rotation). Repeatability (2.77 × technical error of measurement [TEM]) was ± 4.4° for Cobb angles, ± 7.7° for sagittal profile, ± 5.0° for pelvic parameters, ± 4.8° for transverse profile, and ± 100.4° for automated thoracic and lumbar PMC. With strong outliers excluded, thoracic PMC was ± 16.2° and lumbar PMC was ± 15.5°.

Conclusion: 3D EOS measurements demonstrate excellent intra-rater ICC repeatability despite notable true measurement error that should define future success criteria. Semi-automated modelling provides quick 3D spinal alignment measurements from a neutral pelvis, with this study being the first to report TEM for 3D EOS reconstructions. PMC disagreement indicates the need for further investigation.

Objectives: To evaluate whether dual-layer spectral computed tomography, compared with conventional CT, improves diagnostic accuracy for osteolytic vertebral metastases. Furthermore, to investigate the influence of dual-layer CT on the subjective visibility of metastases.

Materials and methods: In this single-center retrospective study, consecutive patients with an untreated primary tumor who underwent dual-layer CT and either MRI or PET-CT as reference standard within 14 days were included. Two independent observers, blinded to the reference, performed two scorings. First, the conventional CT was scored and the results were recorded. Subsequently, Calcium suppression, monoenergetic (monoE40 and monoE200), and Z-effective reconstructions were added. Subjective visibility was compared to conventional CT using a 5-point Likert scale. Diagnostic accuracy measures were calculated with 95% confidence intervals. Sensitivity and specificity were compared using the McNemar's test.

Results: Fourteen patients (63 ± 8 years; 64.3% female) and 189 vertebrae were included, with 46 vertebrae showing 58 metastases with a mean diameter of 18 mm (range 5-53 mm). For conventional CT, the sensitivity, specificity, and diagnostic accuracy for observer A and B were, respectively, 57% and 57%, 96% and 90%, 85% and 81%. The diagnostic performance did not improve when using the dual-layer CT reconstructions in addition to conventional CT (p ≥ 0.13). MonoE40 improved the subjective visibility of metastases. Interobserver agreement was moderate for conventional CT (ĸ:0.48), and dual-layer CT reconstructions (ĸ:0.41-0.51).

Conclusion: Dual-layer CT reconstructions did not improve diagnostic accuracy for osteolytic vertebral metastases compared with conventional CT, although subjective visibility was improved on low monoenergetic reconstructions.

We report a very rare case of an intraossesous extra-axial chordoma (EAC) involving the distal femur. We describe the clinical presentation, radiologic and pathological findings, and the treatment. In addition, a systematic literature search was performed to further expand the knowledge regarding EAC in the lower extremities, including 13 papers describing a total of 21 adult patients.